Water by Design is a capacity building program based in Brisbane, Australia that focuses on waterway health and aims to aid local governments and the development industry in the goal of transitioning to a water sensitive city. Water by Design’s survey of the issues affecting waterway health reveal a very broad suite of problems to solve. This includes diffuse and point source pollution, hydrologic change, riparian disturbance, scour and erosion. With the recent implementation of stormwater pollution offsets schemes across Queensland there is a growing financial budget for waterway improvement projects. There is however many conflicting priorities. Waterway managers are faced with the problem of guessing what management actions (eg. ESC (Erosion and Sediment Control), WSUD (Water Sensitive Urban Design), pollutant source control, stream rehabilitation, fish passage, etc) are best for the environment and how social and economic considerations can be incorporated into the mix. A risk management approach is used to reframe the process to identify critical vulnerabilities. We also explore a number of prioritisation and decision support tools to try and narrow down the options. A ‘threat - barrier’ diagram is used to simplify the complex interactions between urban development and the natural environment. This paper also introduces an ‘opportunity management’ approach to maximise the potential benefits of any interventions.